Long-term inflammation in the temporal artery of a giant cell arteritis patient as detected by ultrasound

Diamantopoulos, Andreas P.; Myklebust, Geirmund

doi:10.1177/1759720x14521109

Cited by 12 publications

(6 citation statements)

References 2 publications

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“…By contrast, Perez Lopez et al documented persistence of the halo sign in 50 % of patients at six months [31]. In line with these fi ndings, it is our and others experience that the halo usually persists over months [32]. Compression US performed with modern high frequency transducers may be useful in more accurately determining the regression of the temporal artery wall thickening in cranial GCA over time.…”

Section: Cranial Giant Cell Arteritissupporting

confidence: 55%

Ultrasound imaging in the diagnosis of large vessel vasculitis

Czihal

Lottspeich

Hoffmann

2017

Vasa

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Summary: Nowadays noninvasive vascular imaging has an important role in the diagnostic work-up of the large vessel vasculitides (LVV), most importantly giant cell arteritis (GCA) and Takayasu arteritis. Among the imaging modalities available, ultrasound (US) has several important advantages, including low costs, rapid and repetitive availability without exposure to radiation, and high spatial resolution for assessment of large and medium-sized arteries. Therefore, US can be regarded the fi rst line imaging method in suspected LVV. In patients with suspected GCA, US can replace temporal artery biopsy in certain clinical scenarios, and the application of US early in the diagnostic work-up of suspected GCA in specialized fast track clinics has been suggested to reduce the rate of visual ischaemic complications and associated costs. In other LVV such as Takayasu arteritis and chronic periaortitis, the diagnostic accuracy in comparison to other noninvasive imaging methods has not been formally tested but can be considered to be excellent. However, quality of US is highly dependent on the operator's experience, and assessment of the thoracic aorta which is frequently involved in GCA and TA is limited. The role of US in the followup of LVV under treatment is unclear. In view of the promising data supporting its value on the one hand and several uncertainties and controversies on the other hand, the present review article provides a comprehensive overview on current evidence for the application of US in the diagnosis and follow up of LVV. Recent multicentre study results and emerging trends such as the application of compression sonography in the diagnosis of GCA and the use of contrast enhanced ultrasound in disease activity assessment in Takayasu arteritis are discussed.

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Section: Cranial Giant Cell Arteritissupporting

confidence: 55%

Ultrasound imaging in the diagnosis of large vessel vasculitis

Czihal

Lottspeich

Hoffmann

2017

Vasa

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“…However, other studies indicate that a halo seldom disappears before 2 months. 8,9,10 All patients with a positive CDUS in our study received a final diagnosis of GCA with the exception of one patient with low risk clinical features (headache, normal inflammatory markers). This patient did not receive steroids prior to CDUS and no halo sign was found but temporal artery thickening was seen, resulting in a classification consistent with a diagnosis of GCA.…”

Section: Discussionmentioning

confidence: 93%

Cranial ultrasound for the diagnosis of giant cell arteritis. A retrospective cohort study

Croft

Thompson

Duddy

et al. 2015

Journal of the Royal College of Physicians of Edinburgh

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Background: Establishing a diagnosis of giant cell arteritis, or indeed ruling it out, may be difficult. We describe an evaluation of temporal artery colour duplex ultrasound as first line investigation in patients with suspected giant cell arteritis. Methods: A retrospective cohort study of all patients undergoing colour duplex ultrasound for suspected giant cell arteritis between January 2005 and January 2014 was undertaken at a teaching hospital. A minimum clinical follow-up of three months was required. Patients were classified on the basis of ultrasound reports, using described features such as a halo sign or arterial wall thickening and clinical diagnosis of giant cell arteritis after at least 3 months follow-up, determined by the treating physician. The relationship of colour duplex ultrasound to a final clinical diagnosis of giant cell arteritis was analysed. Results: A total of 87 patients underwent colour duplex ultrasound: 36 (41%) had clinically confirmed giant cell arteritis at 3-month follow-up. The positive predictive value of colour duplex ultrasound for a clinical diagnosis at 3 months was 97% (95% confidence interval (CI) 93 to 99%) and negative predictive value 88% (95% CI 76 to 95%). Sensitivity was 81% (95% CI 64 to 92%) and specificity 98% (95% CI 90 to 100%). Conclusions: A high positive and negative predictive value of arteritis on colour duplex ultrasound indicates that temporal artery biopsy may be unnecessary in suspected giant cell arteritis, particularly where clinical suspicion of giant cell arteritis is high or low. Keywords 269clinical providers and archived paper medical records as necessary. For the purposes of this study, a clinical diagnosis of GCA made by a consultant rheumatologist, alone or in collaboration with other specialists, after a minimum of 3 months of follow-up, served as the reference or 'gold' standard for a diagnosis of GCA. The American College of Rheumatology (ACR) criteria for GCA were also used to classify all cases for comparison. 4 CDUS was performed on all patients. Examinations were performed by one of two consultant radiologists experienced in vascular ultrasound. Radiologists were not blinded to the suspicion of GCA or clinical data including laboratory test results. Studies were performed using a high-resolution multi-D linear array transducer VFX 13-5 MHz with a Doppler frequency above 6.5 MHz (Hitachi HA700, Hitachi Medical Systems). This probe gives a high frequency range up to 13 MHz and is designed for high resolution imaging of superficial structures. Each patient was examined using standard settings (frequencies of 13.0 MHz for B-mode and 9.0 MHz for colour-mode scanning).Ultrasound examination of the temporal arteries included longitudinal and transverse views of the common superficial temporal arteries and the frontal and parietal branches on both sides as completely as possible (dynamic range 45-50 dB, wall filter low or general, pulse repetition frequency 2250 Hz). The temporal and common carotid artery wall thicknesses on both s...

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“…Schmidt [65]. Persistence up to 7 months has also been reported [66]. A possible explanation for longer lasting halos could be intimal proliferation with fibrosis that is often histologically reported as healed arteritis.…”

Section: Imaging Findings After Initiating Treatment and During Follomentioning

confidence: 90%

Imaging in Giant Cell Arteritis

Khan

Dasgupta

2015

Curr Rheumatol Rep

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Much progress has been made in the use of imaging as a diagnostic tool in giant cell arteritis (GCA), which assists in the management of patients where the initial diagnosis is unclear. This includes patients with atypical cranial symptoms, or with predominantly systemic, constitutional or limb symptoms. Ultrasound and magnetic resonance imaging are capable of visualising both the cranial and extracranial large vessel circulation, with vessel wall thickening and stenotic lesions being visualised. Computed tomographic angiography is helpful in visualising the aorta for aneurysm complicating GCA but can also detect vessel wall thickening in established large vessel vasculitis. PET-CT is a very sensitive test for early vascular inflammation in extracranial large vessel vasculitis, before aneurysmal or stenotic lesions have developed, of use in the patient with unexplained constitutional symptoms. The place of imaging in the follow-up of GCA is being investigated, and repeated imaging may be useful in select cases. Generally, vascular abnormalities become less defined once glucocorticoid treatment has been started, and therefore, imaging studies must be conducted early as part of a GCA fast-track assessment.

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Long-term inflammation in the temporal artery of a giant cell arteritis patient as detected by ultrasound

Cited by 12 publications

References 2 publications

Ultrasound imaging in the diagnosis of large vessel vasculitis

Ultrasound imaging in the diagnosis of large vessel vasculitis

Cranial ultrasound for the diagnosis of giant cell arteritis. A retrospective cohort study

Imaging in Giant Cell Arteritis

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